Cementless Total Hip Arthroplasty with Subtrochanteric Transverse Shortening Osteotomy for Severely Dysplastic or Dislocated Hips

Abstract

Total hip arthroplasty in dislocated developmental hip dysplasia is a complex, technically demanding procedure with high complication rates. Anatomic abnormalities and the young age of the patients influence the results. Restoration of the anatomic hip center often requires shortening of the femur in order to avoid over-stretching of neurovascular structures. We performed cementless total hip arthroplasty with subtrochanteric transverse osteotomy on 44 hips in 31 patients. There were 29 female and 2 male patients. The average age at the time of the operation was 43.2 (range, 22-63 years) and the mean follow up period was 62 months (range, 24-96 months). Harris hip scores improved from 36.2 to 81.2 with good and excellent results in 79.5% of the patients. We stabilized the osteotomy line with low contact plates and screws primarily on 10 hips when rotational stability was in doubt. In the other hips, good initial rotational stability was obtained by the femoral component. However, we observed 5 nonunions in patients whose osteotomies were not stabilized with plates. These patients were later treated successfully with internal fixation and autogenous bone grafting. The osteotomies healed at a mean time of 4 months (range, 2.5-14 months). Postoperatively two dislocations, one acetabular component displacement under the structural bone autograft and two superficial infections were seen. There were no cases of symptomatic loosening, deep infection, or neurovascular injury. Subtrochanteric transverse osteotomy is a versatile, relatively easy and reliable method for shortening the femur when performing cementless total hip arthroplasty in hip dysplasia cases. This technique makes it possible to implant standard sized cementless femoral stems. When necessary, tortional stability may further be augmented with a plate and screws.

Transverse Subtrochanteric Shortening Osteotomy During Cementless Total Hip Arthroplasty in Crowe Type-III or IV Developmental Dysplasia

“…To our knowledge, this is the largest reported series in which the clinical outcomes of transverse subtrochanteric femoral shortening osteotomies performed during cementless THA in Crowe Type-III and IV DDH were evaluated. The mean Harris hip score and the mean pain component of it improved significantly in our study group similar to the results reported in the literature [1,4,6,7,20,22]. Improvement in the pre-operative limp was also significant in the majority of our patients.…”

“…Moreover, they mentioned that graft application did not have a significant contribution to stability. Yalcin et al reported that they did not use plate-screw stabilization when good initial rotational stability was obtained by the femoral component, but they used low contact plates and screws primarily when rotational stability was in doubt [7]. However, they observed 5 non-unions in patients whose osteotomies were not stabilized with plates.…”

“…Placement of the acetabular component in the true acetabulum generally requires a femoral shortening osteotomy in most of the cases. Although various techniques of shortening osteotomy with satisfactory clinical outcomes have been discussed in the literature, no consensus has been established yet [7][8][9][13][14][15][16][19][20][21]. To our knowledge, this is the largest reported series in which the clinical outcomes of transverse subtrochanteric femoral shortening osteotomies performed during cementless THA in Crowe Type-III and IV DDH were evaluated.…”

“…However, placement of the acetabular component in the true acetabulum generally leads to a hip that is difficult to reduce because of severe soft tissue contractures, and a limb which is relatively lengthened [6]. Femoral shortening osteotomy is required in most cases to facilitate reduction, equalize limb lengths, and avoid overstretching of neurovascular structures [5,[7][8][9]. Furthermore, it will also allow correction of the femoral malrotation.…”

“…Anatomic levels are greater trochanter, subtrochanteric region of the proximal femoral metaphysis, and distal femur [10][11][12]. Subtrochanteric osteotomies can be performed as transverse, oblique, Z-shaped, or double Chevron [7,8,[13][14][15][16]. Fixation of the osteotomy can be obtained by using cables or a plate system.…”